Enhanced recovery after surgery vs conventional care in emergency colorectal surgery

Table 1 Summary of enhanced recovery after surgery programme and comparison with conventional care pathway

Primary component	ERAS programme	Conventional care pathway
Before surgery	Detailed information and education, including breathing exercise, mobilisation, dietary goal, and estimated length of hospital stay	Advice given by an on-call consultant surgeon
During surgery	Standard anaesthetic protocol (balanced general anaesthesia) and surgical management	Standard anaesthetic protocol (balanced general anaesthesia) and surgical management
	Transverse abdominal incision for right-sided colon cancer surgery	Midline incision with the application of Balfour self-retaining retractor
	Manual colonic decompression prior to primary anastomosis in obstructing left-sided colorectal cancer	Intra-abdominal or pelvic drainage at the surgeon’s discretion
	No intra-abdominal or pelvic drainage	No standard protocol for prophylaxis of PONV
	Application of O-ring wound retractor (Alexis® Retractor)
	Active warming (warm intravenous fluid, Bair Hugger®, warm saline-soaked swab around the intestine)
	Infiltration of 0.5% bupivacaine into fascial layer and skin before wound closure
	Prophylaxis of PONV based on risk factors
After surgery	Fluid therapy to keep a urine output of 0.5-1 mL/kg per hour, with deliberate administration of colloid solution if needed	Care decided by consultant surgeon
	Early removal of NGT at 24-48 h postoperatively unless there was > 400 mL drainage in a 24-h period	Crystalloid fluid replacement
	Early ingestion of oral intake after NGT removal	NPO until patients passed flatus, had an active bowel sound and NGT content < 400 mL/d
	Multimodal analgesia with the preferential use of selective cyclo-oxygenese 2 inhibitors	Intravenous opioids as a primary modality for postoperative analgesia
	Scheduled removal of urinary catheter at 48-72 h postoperatively in a stable patient
	Regular mobilisation with daily physiotherapy
	Aim to discharge on postoperative d5
After discharge	Telephone call 3 d and 1 wk after discharge	2 wk and 30 d follow-up in clinic
	2 wk and 30 d follow-up in clinic

ERAS: Enhanced recovery after surgery; NGT: Nasogastric tube; NPO: Nil per os; PONV: Postoperative nausea and vomiting.